Pain practice : the official journal of World Institute of Pain
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Trigeminal neuralgia (TN) is the most common cause of facial pain, leading to significant disability and impacting a patient's quality of life. Percutaneous procedures like continuous radiofrequency, pulsed radiofrequency (PRF), and combined continuous and pulsed radiofrequency have been studied in past years comparing different voltages in order to find more effective therapies with fewer complications (eg, numbness and masseter muscle weakness). With regard to young patients, there is still insufficient evidence on the most appropriate procedure in this patient population. PRF does not cause thermal damage. The mechanism of action involves delivering an electrical field to targeted nerves or tissues, modulating pain. We propose that bipolar pulsed radiofrequency (2 parallel cannulas) in the trigeminal ganglion produce a denser and larger field resulting in more effective controlled pain. ⋯ Bipolar PRF could be a non-neurodestructive option for young people with TN and deserves further investigation as a treatment option.
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Review Meta Analysis
Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy. ⋯ This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy.
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Spinal malignancy-related pain results from tumor, fracture, instability, inflammation, and/or nerve root/spinal cord compression. Systemic corticosteroids are commonly used but have many undesirable adverse effects that impact quality of life and continuation of cancer treatments. Epidural steroid injections (ESIs) may be a viable alternative pain treatment. ⋯ There is inconclusive evidence to use ESIs to treat spinal malignancy-related pain in the current literature. Our retrospective review provides level III evidence for our conclusion that ESIs are safe and efficacious to treat spinal malignancy-related pain. Thoracic/lumbosacral injections led to significantly better pain relief compared with caudal injections.
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Perioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short-term and long-term benefits and safety of ketamine after breast surgery. ⋯ Ketamine is an effective and safe multimodal analgesic in patients undergoing breast surgery, administered both intravenously and when added to bupivacaine in paravertebral blocks. In addition, ketamine showed a long-term benefit for preventing postoperative depression and postmastectomy pain syndrome.
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Comparative Study Observational Study
Peripheral Nerve Blockade with Combined Standard and Liposomal Bupivacaine in Major Lower Extremity Amputation.
Optimizing perioperative analgesia for patients undergoing major lower-extremity amputation remains a considerable challenge. The utility of liposomal bupivacaine as a component of peripheral nerve blockade for lower-extremity amputation is unknown. ⋯ Peripheral nerve blockade is associated with reduced opioid requirements after lower-extremity amputation compared with general anesthesia alone. However, the incorporation of liposomal bupivacaine is not significantly different to blockade employing only standard bupivacaine.